Probe clears UCLA over transplants
Federal investigators found no evidence that UCLA Medical Center or its staff acted improperly when it performed liver transplants on four Japanese patients with suspected links to organized crime in their country, according to an official with the U.S. Centers for Medicare and Medicaid Services.
But an influential senator still is seeking to determine whether policies governing transplant recipients are flawed.
Sen. Charles E. Grassley, the senior Republican member of the Senate Finance Committee, and the Centers for Medicare and Medicaid Services launched separate inquiries after The Times published two articles in May detailing the transplants.
U.S. transplant guidelines allow hospitals to provide organs to patients with criminal histories and to a limited number of foreigners.
But the four surgeries, performed between 2000 and 2004, were controversial because of a pronounced shortage of liver donors in the United States and because two of the patients contributed $100,000 each to the Westwood hospital a few months after their surgeries, The Times reported.
Earlier this year, UCLA told The Times that the hospital was unaware of the men’s suspected ties to Japanese gangs, commonly known as yakuza, at the time of the surgeries and that the men’s financial gifts had no bearing on their transplants.
A Medicare Services team visited the hospital for three days in late June and found that the livers offered to the Japanese patients had been turned down by other candidates because of concerns about size and quality, according to records reviewed by The Times.
In one case, the donor was 14 years old. Although two pediatric patients were ranked higher on the list than the Japanese recipient, they were younger than the donor, and the liver was deemed too large for them.
In another case, there was concern about the liver’s function and the amount of time between its removal and when it was placed on ice.
“There was no evidence of misapplied policies, preferential treatment,” said Angela Brice-Smith, deputy director of Medicare Services’ survey and certification group.
Grassley, however, wants more information.
“I don’t see any evidence of wrongdoing in the events at UCLA, but broader questions remain,” Grassley said in an e-mail to The Times last week. “With such organ scarcity, how are we going to ensure that available organs are given to recipients in a way that is fair and medically sensible? . . . Should available organs in the United States be made available to those outside of the country?”
Grassley wrote a letter last week to the United Network for Organ Sharing, the federal contractor charged with ensuring the safety and fairness of the nation’s transplant system.
In it, Grassley noted that one of the Japanese patients was ranked between 500th and 600th on the list of compatible candidates when he received a liver in 2004.
Among other things, Grassley asked the network how common it is for a candidate ranked that low on a waiting list to receive an organ. Another Japanese patient was in the top 10 and the rest were ranked between 50th and 300th on the list.
The letter also noted that apart from the two $100,000 gifts reported by The Times, the patients paid between $300,000 and about $400,000 apiece for their treatment.
One of the patients also gave a UCLA physician $10,000, a watch and a case of wine, according to Grassley’s letter, which was reviewed by the newspaper.
UCLA did not identify the physician to committee staff and declined to discuss details of any of the cases with The Times, citing federal patient-privacy laws.
All four surgeries were performed by Dr. Ronald W. Busuttil, executive chairman of UCLA’s surgery department. His office referred a request for comment to the UCLA media office.
Dr. J. Thomas Rosenthal, chief medical officer for UCLA Health System, said the hospital adheres to the policies set by the organ network.
“UCLA underwent a thorough onsite CMS review, and [we] were found to be in total compliance with all organ allocation and distribution policies,” Rosenthal said in an e-mailed statement.
Although it is not unusual for grateful patients to make gifts to hospitals and physicians, there is debate about the ethics of accepting them.
“Normally, when you start to get donations in the six figures, you start asking where is it coming from,” said Arthur Caplan, a bioethicist at the University of Pennsylvania.
As for gifts made directly to a physician, he argued that accepting anything worth more than about $100 was a “big ethical no-no” in transplant cases because “it creates the appearance that the wealthy are going to get priority or better attention.”
He said that the entire system is based on people voluntarily donating organs, which they might not do if they think the system is unfair.
The liver allocation system is supposed to balance a candidate’s need with the chances of a successful transplant. When an organ becomes available, a list of compatible recipients is generated. Numerous factors are taken into account, including the candidate’s age and blood type, the progression of disease and the amount of time spent waiting.
In the past, allegations have arisen at other hospitals that wealthy foreigners were allowed to move up the transplant list in exchange for financial contributions.
Organ network spokeswoman Anne Paschke said federal law requires that decisions about organ allocation be based on medical criteria alone.
Because of the shortage of organs, however, U.S. hospitals are asked to ensure that foreigners who do not live here account for no more than 5% of transplants.
UCLA exceeded the guidelines only once between 2000 and 2007, the network told Senate staffers. In 2001, 6.3% of its liver transplants were for nonresident foreigners.
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